Process of Report Preparation
Background and Purpose
This technical report, prepared by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, is the third in a continuing series intended to provide information and assistance to state mental health commissioners/directors on emerging issues of clinical concern. Topics for technical reports are identified by the Medical Directors Council in conjunction with the NASMHPD leadership. Technical reports are developed by members of NASMHPD Divisions, NASMHPD Affiliates, and outside experts.
Increasingly, state mental health agencies are required by their legislatures to provide treatment to persons civilly committed under sexually violent predator statutes following the expiration of their criminal sentences. A number of state mental health commissioners/directors have requested guidance in developing and implementing treatment programs required by these statutes. NASMHPD responded to these requests by convening a task force including professionals in the field of sexual offender treatment, two of whom are directors of treatment programs designed specifically for persons civilly committed under sexually violent predator statutes.
At present, states typically fall into three categories: (1) those that have passed legislation requiring their state mental health agencies to develop and operate programs for persons civilly committed for treatment under sexually violent predator statutes; (2) those with pending legislation or which are deliberating the adoption of statutes to establish civil commitment procedures and treatment programs for sexually violent predators; and (3) those seeking alternative means of
responding to persons who are determined to be sexually violent predators (e.g., extended incarceration, lifetime parole with intensive supervision). This report is intended to serve as an initial "best practices" guide for state mental health agencies that fall into the first two categories to ensure comprehensive treatment and security
for this population.
This report contains principles specific to treatment, public safety, and patient rights. One section of this report describes several "lessons learned" by existing treatment programs. The report concludes with specific recommendations to NASMHPD and state mental health agencies for developing treatment programs for persons civilly committed under sexually violent predator statutes, programs that meet the needs of this population and that protect the communities in which they live.
Preparation of the Report
This report was prepared from proceedings of a meeting held April 25 through 27, 1999 in Portland, Oregon. Meeting participants included two state medical directors, two representatives from state offices of consumer affairs, representatives of three NASMHPD Divisions, five experts in the field of the treatment of sexual offenders, and NASMHPD staff. A facilitator and a technical writer assisted in the
proceedings. A list of participants and their affiliations is included in the Appendix. It is important to note that views expressed by the participants were their own and are not necessarily endorsed by their organizations.
Prior to the meeting, participants reviewed materials related to sexual offenders in general and sexually violent predators in particular, including research literature and case law, examples of institutional and community treatment programs, information related to special populations, and references to risk reduction and recidivism. The materials did not represent an exhaustive search of current information about these
populations, but sought to establish an informed basis for group discussion. This report attempts to integrate findings of the literature with the diverse perspectives and experiences of the participants.
Editorial Review
Drafts of this report were prepared by the technical writer and chief editor and distributed for review and comment to all meeting participants and members of the Medical Directors Council's Editorial Board.
The final report was reviewed, amended, and approved by the Medical Directors Council and does not necessarily reflect the viewpoint of the NASMHPD membership.
Defining the Issues: Problem Statement and Group Consensus
Problem Statement
The practice of civilly committing persons to state mental health agencies for treatment under sexually violent predator statutes following completion of their criminal sentences was upheld by the 1997 U.S. Supreme Court decision in Kansas v. Hendricks. In light of this precedent, a growing number of states have created
programs for the treatment of persons civilly committed under sexually violent predator statutes. Emerging case law (e.g., Turay v. Seling) further clarifies the mandates for state mental health agencies to provide "adequate" treatment for sexually violent predators, to carefully define terms and conditions for their continuing confinement, and to make thoughtful release decisions. As new treatment programs are developed, it can be expected some of them will be subjected to legal tests to determine the appropriateness and effectiveness of their
therapies and the adequacy of their discharge criteria and processes. It can also be expected that the fiscal impact of such programs on states will continue to increase in proportion to the number of persons civilly committed under these statutes.
The majority of sexually violent predator statutes are adapted from those originally enacted by the State of Washington. The Washington statutes provide for the civil commitment of "any person who has been convicted of or charged with a crime of sexual violence and who suffers from a mental abnormality or personality disorder which makes the person likely to engage in predatory acts of sexual violence if not confined in a secure facility" (Revised Code of Washington, 71.09.020(1)).
Washington-type predator statutes respond to the shift by states from indeterminate sentencing laws to determinate sentencing statutes. Indeterminate sentencing laws gave extensive authority to parole boards to pass over certain inmates for early release. Determinate sentencing statutes restrict the authority of parole boards and largely fix criminal sentences at specified lengths and have the effect of making it
impossible to confine offenders beyond relatively short periods of time.
Statutes typically permit individual states to develop criteria for determining who among all convicted sexual offenders present the greatest danger to public safety if not civilly committed for treatment. Sexually violent predator statutes, therefore, target only a small subpopulation of persons convicted of sexual offenses.
Statutes for the civil commitment of sexually violent predators are variations of laws governing civil commitment of persons affected by mental illness or mental retardation that make them unable to care for themselves or that put them at risk of harming themselves or others. The U.S. Supreme Court decision in Kansas v. Hendricks noted that the purpose of the Kansas law was for treatment (and not just for continued confinement or for further punishment) and placed an obligation upon
the state to provide that treatment. In this regard, the Kansas law is the same as all other Washington-based sexually violent predator laws. These laws all presume that when the state properly detains persons because of their mental condition, the state is then obligated to provide them with care and treatment until they are deemed safe to again live in the community.
Persons civilly committed to these treatment programs become patients of the mental health system upon admission. These persons must be afforded rights consistent with those granted to other patients in the mental health system, with consideration for their need for supervision. Thus, in fundamental ways, programs for persons civilly committed for treatment under sexually violent predator statutes do not appear to differ substantially from other treatment programs offered by state
mental health agencies.
As with other state civil commitment requirements, programs for persons civilly committed under sexually violent predator laws must balance three critical elements: (1) treatment; (2) public safety; and (3) patient rights. In essence, treatment programs must recognize the range of needs presented by these persons and ensure that these needs are addressed by a comprehensive array of services delivered in a variety of appropriate settings.
For the reasons given above, state mental health agencies should consider cautious development and implementation of treatment programs for persons civilly committed under sexually violent predator laws.
Consensus Reached by Participants
In September 1997, the NASMHPD membership adopted the position that
"treatment programs for dangerous sexual offenders should be administered and funded outside the state mental health agency" and that these persons should be managed "through sentencing or other alternatives within the criminal justice system" ("NASMHPD Policy Statement on Laws Providing for the Civil Commitment of Sexually Violent Criminal Offenders").
In contrast to the 1997 NASMHPD position, participants at the April 1999 meeting agreed that programs for persons civilly committed for treatment under sexually violent predator statutes may indeed fall under the administrative purview of state mental health agencies. The change in position endorsed at this meeting acknowledges the reality that increasingly state legislatures are requiring state mental health agencies to operate these specialized programs, and recognizes the
experiences being accumulated by those programs currently in operation.
Participants at the April 1999 meeting achieved further consensus in areas described below.
Treatment programs for persons civilly committed under sexually violent predator statutes should use the generally accepted principles of a public health model. The public health model addresses prevention at three levels: (1) primary prevention (in this context, community education and identification of at-risk individuals); (2)
secondary prevention (treatment of prepatterned and patterned sexual offenders on probation or during incarceration in corrections or other forensic systems); and (3) tertiary prevention (in this case, civil commitment and treatment under sexually violent predator statutes).
The tertiary prevention model is the focus of this technical report. Public health systems also attempt to balance the rights and needs of individuals with the needs of the larger community, a necessary practice for programs serving persons civilliy committed for treatment under sexually violent predator statutes.
States required to operate treatment programs under sexually violent predator statutes should collaborate with departments of corrections to ensure that sexual offender treatment programs are available during incarceration. Treatment during incarceration may preclude the need for treatment under civil commitment.
State mental health agencies required by statute to provide treatment should involve themselves from the beginning to plan and implement programs and to invest the time, energy, and resources necessary to ensure the development of state-of-the-art treatment systems. State mental health agencies should provide ongoing support to these programs given the complex and difficult work they do. Involvement by community allies, e.g.; County Sheriff Departments/County Social Service Departments, is also critical to the support of these programs.
Professionals in the field of treatment of sexually violent predators should design and operate these programs in close consultation with family and consumer advocacy organizations, representatives from the community, and other mental health agencies and providers.
Treatment programs should offer a comprehensive array of services, including ongoing assessments, therapies, supports, supervision, and monitoring tailored to individual needs. As with any other mental health program, treatment programs for persons civilly committed under sexually violent predator statutes should anticipate the wide range of needs of this population (e.g., juveniles, persons with mental illnesses, mental retardation and/or developmental disabilities, substance abuse
issues, traumatic brain injuries, those with sensory or other physical impairments, persons with primary care needs, women, the elderly) and take any measures necessary to accommodate individual needs and functional abilities.
Programs for persons civilly committed for treatment under sexually violent predator statutes should have well-defined criteria for assessing patient progress and for making discharge recommendations; these criteria must be clearly understood by patients, treatment staff, mental health agency personnel, and the community.
It is especially important for good public relations that community allies be involved in developing transition services for persons completing secure treatment who are ready for less restrictive placement. Public education should be ongoing.
Protracted, supervised releases into communities of persons completing civil commitment treatment in institutions are essential to reinforce the continuing goals of treatment, to enhance public safety, and to reduce the probability of relapse or committing additional offenses. Community transition programs integrated with institutional programs appear to offer the best continuity of services and the most secure supports for persons being released from secure inpatient programs. State
mental health agencies should retain legal and supervisory responsibility for those on release to ensure public safety and continuity of treatment.
Findings: Research, Principles, and Key "Lessons Learned"
Overview of Research Findings
This section of the report is a brief overview of treatment methods currently being used with sexual offenders, drawn both from the literature and from discussions held during the April 1999 meeting. The majority of treatment programs for persons designated as sexually violent predators draw on therapeutic principles applied to sexual offenders in general. Given the relative newness of treatment programs designed for sexually violent predators, limited research has so far appeared in the literature specific to this population. No attempt is made here to
describe all known treatment methods used with sexual offenders. Recidivism as an outcome measure of sexual offender treatment effectiveness is briefly addressed.
Literature on the treatment of sexual offenders does not guarantee therapeutic cures for criminal, sexually violent, predatory behavior. The literature does suggest that treatment can be effective with some offenders by increasing their impulse control, helping them take personal responsibility for their behavior, and reducing the probability of their reoffending. At present, the literature presents no treatment
standards specific to the smaller subpopulation of persons civilly committed under sexually violent predator laws; therefore, current treatment programs are, in effect, evolving independently. Treatment outcomes for these programs have not been fully tested for their appropriateness and effectiveness. Service research is needed
to establish the effectiveness of treatments and outcomes for this population.
Somatic Therapies: Somatic treatments typically range from irreversible surgical procedures (e.g., castration) to the use of medications, including antiandrogens and serotonergic agents. In general, somatic therapies appear beneficial only as part of comprehensive sexual offender programs that also include cognitive and behavioral therapies. Surgical treatment options may be effective with some persons determined to be sexually violent predators; however, ethical concerns limit the use
of these procedures and raise questions regarding the validity of informed consent, particularly if consent is obtained contingent on release decisions.
Antiandrogens (e.g., medroxyprogesterone acetate) are currently thought to be highly effective with some sexual offenders by reducing serum testosterone levels and deviant sexual arousal patterns. Routine psychiatric and medical consultation is strongly advised with the use of any somatic therapies, including the use of antiandrogens. The literature suggests increasing successes in reducing obsessive,
deviant thoughts and fantasies through the use of selective serotonin reuptake inhibitors (SSRIs). However, the majority of these studies have relied upon self-report measures rather than more objective measures such as sexual arousal or recidivism. SSRIs are also proving successful with some offenders who have concurrent mood or anxiety disorders.
The use of any somatic therapy is best determined on a case-by-case basis and initiated only after obtaining written informed consent from the individual. In the use of antiandrogens, informed consent procedures should describe the specific rationale for using the medications, the intrusive nature of their use, the current lack of FDA approval for these medications in sexual offender treatment, and require the
patient's written acknowledgment of these considerations. Somatic treatments should be considered only as one factor in discharge recommendations. Any use of medication while on release should include routine laboratory testing, supervision, monitoring, and other appropriate follow-up.
Psychological and Behavioral Therapies: Numerous research studies point to the effectiveness of cognitive-behavioral therapies with sexual offenders. The majority of current programs for persons civilly committed for treatment under sexually violent predator statutes use these therapies as core treatment components. Individual techniques are developed based on ongoing assessments of the offender, including the identification of personal risk factors. Elements of cognitive-behavioral programs are diverse and include: training and education modules (e.g., social skills, empathy development, cognitive restructuring); aversive therapy or
covert sensitization as appropriate (e.g., arousal reconditioning); developing relapse prevention plans based on offending patterns and risk factors; the use of adjunctive experiences and activities (e.g., vocational training, substance abuse treatment); and
establishing support systems for the offender.
For maximum sustained benefit, cognitive-behavioral therapies must be consistent over changes in the person's placement (i.e., in institutional programs, in the community) to prevent the therapy's benefits from diminishing over time.
Additional technologies currently being used in sexual offender treatment that may be effective for persons civilly committed for treatment under sexually violent predator statutes include polygraphy and penile plethysmography.
Recidivism: Historically, the commission of new sexual offenses has been the primary outcome measure used to determine treatment success with sexual offenders. Recidivism rates reported in the literature range from less than 10 percent to nearly 100 percent. The range of reported recidivism rates depends, in part, upon the definition of recidivism used (e.g., ranging from committing any type of criminal offense to committing only those sexual offenses that result in reincarceration), the type of offender being studied, and the research design
employed. As stated previously, outcome measures have yet to be developed specifically for the small subpopulation of persons who are civilly committed for treatment under sexually violent predator statutes. Recidivism may not be a practical measure for this population.
Principles for Treatment, Public Safety, and Patient Rights
Discussion at the April 1999 meeting yielded the following principles, based on a reading of the literature on sexual offenders and the participants' experience in clinical practice. Programs for persons civilly committed for treatment under sexually violent predator laws should be developed and implemented based on the best knowledge and research available at the time and must balance elements of
treatment, public safety, and patient rights.
Principles Governing Treatment
- Equivalence: Treatment programs designed and operated for persons civilly committed under sexually violent predator statutes should offer a range and a quality of services equivalent to programs for others
receiving mental health services.
- Treatment services should be developed and implemented with a full array of resources to meet the needs of this population
delivered in any appropriate setting.
- The array of services should include ongoing assessments,
therapies, supports, supervision, and monitoring based on
individual needs.
- Ethics: An explicit set of ethical guidelines for professional staff and treatment should be incorporated into any program serving this population.
- As one example, the ethical standards adopted by The
Association for the Treatment of Sexual Abusers (1997) could serve as a model both for treatment programs and for providers
of service for persons civilly committed for treatment,
specifically those standards that pertain to: (a) professional conduct; (b) client relationships; (c) confidentiality; (d)
professional relationships; (e) research and publications; and (f) public information and advertising.
- Program and Training Standards: Programs for persons civilly committed for treatment under sexually violent predator laws should be state-of-the-art and should incorporate the most up-to-date treatment modalities and technologies. Training for staff should be continual and specific to the needs of the population being served.
- Programs should have well-defined standards for determining patient progress in treatment, and clear discharge criteria by which to make continued stay or release recommendations.
- Treatment programs should have standardized, written informed consent procedures for each treatment modality offered.
- Staff working in these programs should be specially trained in the disorders presented by this population and the treatments
and supports used to address these disorders.
- Consumer groups and advocacy organizations, representatives from the community, and other mental health agencies and
providers should be invited to participate in the design and operation of treatment programs for persons civilly committed
under sexually violent predator statutes.
- States should include information about these programs in their mental health public education efforts. Public education should
address the nature of the population being served, the treatment modalities, and the risk management strategies in use. The
public should be informed about these programs to promote
community reintegration once these persons have successfully completed inpatient treatment.
- Treatment programs should be licensed or be given routine, external oversight.
- Programs should be affiliated with institutions capable of service research to determine the effectiveness of assessment, treatment, supervision, and other program indicators; one goal of research should be to develop and evaluate specific outcome and performance measures for this population.
- Standards Specific to Individual Treatment: Treatment for persons civilly committed to programs under sexually violent predator laws should be tailored to the individual, his or her needs, and functional abilities.
- Assessments should attempt to identify individual behavioral variables that can be used to manage or control risk behaviors.
- A variety of specialized assessment processes may be used by treatment programs. For example, assessments may be
conducted to clarify diagnostic issues, to gauge amenability to specific treatment, to determine risk factors, or to make
recommendations to the courts. Specialized assessments should be used for the purpose for which they are intended, and the
results should not be generalized beyond the scope of that
purpose.
Principles Governing Public Safety
- Security and Supervision: Institutional and community programs for persons civilly committed for treatment under sexually violent predator statutes should incorporate comprehensive security and supervision procedures to promote the safety of staff, persons in treatment, and citizens in surrounding communities.
- Treatment programs should have crisis management procedures
in place for dealing with high-risk, dangerous situations.
- Treatment programs should seek support from the courts in
devising secure, well-supervised transition services.
- Treatment programs for persons civilly committed under
sexually violent predator statutes should integrate principles of treatment and support from mental health systems with security principles accepted by departments of corrections and other
forensic systems.
Principles Governing Patient Rights
- Individual Rights: Persons civilly committed to treatment programs under sexually violent predator laws become patients in the mental health system and should be granted patient rights endorsed by
national and state mental health programs, consistent with their needs for supervision.
- Treatment should be sensitive to those persons who have themselves been victims of abuse.
- Treatment programs and staff should be competent in cultural and diversity issues represented by this population.
Key "Lessons Learned"
Programs for persons civilly committed for treatment under sexually violent predator laws are continuing to develop; therefore, they may differ in some aspects from conventional work with sexual offenders. Treatment programs for this population require program staff to have special approaches, perceptions, and attitudes to ensure that effective therapies and security are provided. Participants at the Portland meeting discussed a number of lessons learned from programs for
persons civilly committed for treatment under sexually violent predator laws. This section is a synopsis of those lessons.
- Offenders do not enter these treatment programs voluntarily. As a result, many persons resist or refuse to participate in treatment. One program director estimated that, at present, 25 percent of all persons civilly committed to that program resist or refuse treatment. Programs should make concerted, continuous efforts to persuade and engage those who resist or refuse to participate.
- Recruitment and retention of high quality staff to work in these programs is often difficult. Many programs operate in remote areas or compete with higher paying, career positions in departments of corrections. Programs should be prepared to offer competitive salaries and benefits in order to attract and retain qualified professional staff.
- Every effort should be made to complete the process for civilly committing sexually violent predatory offenders for treatment before their criminal sentences expire. Completing the civil commitment process before treatment begins can reduce patients' confusion about their legal status and may avoid compromising their willingness to engage in treatment.
- States are urged to develop interim placements for those persons whose criminal sentences have expired, but who are not yet civilly committed for treatment.
- Irreversible surgical procedures (e.g., castration) may be viable treatment options for some persons; however, such procedures present ethical concerns about coercive treatment, especially if they are tied to pending release decisions. Irreversible surgical procedures should be performed only under direct court order.
- Some persons civilly committed for treatment will age in place as they are determined not appropriate for release. Treatment programs should be prepared to address the changing needs of those who will remain in programs as they age.
- Community transition programs integrated with institutional programs appear to offer the best continuity of services and security for the program participant and the safety of the community.
- Persons designated as sexually violent predators may be highly skilled social manipulators who are capable of testing staff to the extreme. Staff should receive training regularly on how to manage staff-patient boundary issues and should be provided regular supervision and consultation.
- Staff in these treatment programs should be informed, to the extent possible, of the toll this work may take on all aspects of their lives. Staff should be encouraged to develop personal care strategies and participate in peer support
systems.
- Staff should be trained to deal with the contentious nature of patients in these programs. For example, staff should be trained to handle the substantial number of grievances and complaints filed by patients, many of which may result in legal action. State's attorneys general should consult regularly with these treatment programs given the litigious nature of the population being served.
Recommendations for NASMHPD
This technical report is intended to serve as an initial best practices guide to states directed by their legislatures to design and implement programs for persons civilly committed to treatment under sexually violent predator statutes. This report is presented with the understanding that programs for this population will continue to evolve and that state mental health agencies will become increasingly sophisticated in the delivery of these special services. The NASMHPD Medical Directors Council recommends that the NASMHPD leadership take steps to encourage states to report their experiences and to further define "best practices" for these specific populations and treatment programs. In addition, the Medical Directors Council specifically recommends that NASMHPD take the following actions:
- Take a national leadership role in the development of treatment standards for programs for persons civilly committed to state mental health agencies under sexually violent predator statutes. NASMHPD should seek participation by all its applicable Divisions and Affiliates (e.g., Children, Youth, and Families Division, Forensic Division), and other experts in the treatment of sexual offenders.
- Inform the NASMHPD Research Institute (NRI) of the need for research in this evolving area, including research on treatment effectiveness and service outcomes. Invite NRI representatives to participate in NASMHPD Division and Affiliate meetings specific to this population and these specialized programs.
- Encourage the National Technical Assistance Center for State Mental Health Planning to develop and offer training programs and consultation services specific to programs for persons civilly committed for treatment under sexually violent predator statutes.
- Disseminate new materials and reports to state mental health agencies and interested parties on topics related to the treatment of this population, model program development, case law, research findings, and other relevant issues.
- Consult with the NASMHPD Commissioners/Directors about updating the
Association's 1997 "Policy Statement on Laws Providing for the Civil Commitment of Sexually Violent Criminal Offenders" in light of the findings and recommendations in this technical report.
Recommendations to State Mental Health Agencies
The NASMHPD Medical Directors Council recommends that state mental health
agencies required to develop and implement programs for persons civilly committed for treatment under sexually violent predator statutes take the following actions:
- Develop, implement, and support programs for persons civilly committed for treatment under state sexually violent predator laws. In this leadership role, ensure that these programs balance the needs of treatment, public safety, and patient rights.
- Ensure that programs provide services equivalent to those offered to other populations served by mental health and see that these programs adhere to rigorous ethical guidelines.
- Actively encourage state and community stakeholders to develop and
implement collaborative resources for this population to promote treatment and public safety.
- Educate the public to understand the nature of the sexually violent predator population being served, the goals of the treatment program, the risk management strategies being used, and the need for integrated, extended, supervised transitional services.
- Incorporate ongoing service research programs in the development and
implementation of programs for persons civilly committed for treatment under sexually violent predator laws.
- Communicate program experiences to mental health commissioners/directors in other states to speed the development of state-of-the-art treatment programs for this population.
Appendices
Selected References
The Association for the Treatment of Sexual Abusers, 1997. Ethical Standards and Principles for the Management of Sexual Abusers, pp. 2-8.
Dwyer, S. M., 1997. "Treatment Outcome Study: Seventeen Years After Sexual Offender Treatment," Sexual Abuse: A Journal of Research and Treatment, 9(2), 149-161.
English, K., 1998. "The Containment Approach: An Aggressive Strategy for the Community Management of Adult Sex Offenders," Psychology, Public Policy, and Law, 4(1/2), 218-235.
Grossman, L. S., Martis, B. M., and Fichtner, C. G., 1999. "Are Sex Offenders Treatable? A Research Overview," Psychiatric Services, 50(3), 349-361.
Marques, J. K., 1995. "How to Answer the Question, Does Sex Offender Treatment Work?,'" paper presented at the International Expert Conference on Sex Offenders, Utrecht, the Netherlands, September 1995.
Marques, J. K. and Day, D. M., 1998. "Sexual Offender Treatment and Evaluation Project Progress Report." Report to the Legislature. Sacramento, California, Department of Mental Health.
Marques, J. K., Nelson, C., and Alarcon, J. "Preventing Relapse in Sex Offenders: What We Learned from SOTEP's Experimental Treatment Program." Chapter submitted for publication in D. R. Laws, S. M. Hudson, and T. Ward, 1999, Remaking Relapse Prevention with Sex Offenders: A Sourcebook. Thousand Oaks, California: Sage.
National Association of State Mental Health Program Directors, 1997.
"NASMHPD Policy Statement on Laws Providing for the Civil Commitment of Sexually Violent Criminal Offenders." Alexandria, Virginia.
MEDICAL DIRECTORS COUNCIL
Rupert Goetz, M.D.
Medical Director
Department of Human Resources
Mental Health & Developmental Disability
Services Division
2575 Bittern Street, NE
Salem, OR 97310
Ph: (503) 945-2989
Fax: (503) 373-7327
e-mail: goetzr@mail.mhd.hr.state.or.us
Alan Q. Radke, M.D., M.P.H.
Medical Director
Department of Human Services
444 Lafayette Road, North
St. Paul, MN 55155-3826
Ph: (651) 582-1881
Fax: (651) 582-1804
e-mail: alan.q.radke@state.mn.usa
FORENSIC DIVISION
Roger D. Smith, D. Crim.
Director
Bureau of Forensic Mental Health Services
Department of Community Health
3511 Bemis Road
Ypsilanti, MI 48197
Ph: (734) 434-5442
Fax: (734) 434-8813
e-mail: smithro@state.mi.us
LEGAL DIVISION
John House, J.D.
Senior Staff Counsel
Office of the General Counsel
Department of Social & Rehabilitative
Services
15 S.W. Harrison Street, #530
Topeka, KS 66612-1570
Ph: (785) 296-3967
Fax: (785) 296-4960
e-mail:
CHILDREN, YOUTH, & FAMILIES
DIVISION
EXPERTS
Robert Ceasar, Ph.D.
Director, Juvenile Justice Affairs
Department of Mental Health
William S. Hall Psychiatric Institute
P.O. Box 202, 1800 Colonial Drive
Columbia, SC 29202
Ph: (803) 898-1542
Fax: (803) 898-1617
e-mail:
NAC/SMHA
Joyce Jorgenson
Director
Office of Consumer Affairs
Department of Human Services
444 Lafayette Road
St. Paul, MN 55155-3828
Ph: (651) 582-1814
Fax: (651) 582-1831
e-mail: joyce.a.jorgenson@state.mn.us
Frank Armstead
Director of Consumer Relations
Department of Health & Social Services
Division of Alcohol, Drug Abuse, and
Mental Health
1901 N. Dupont Highway
Main Administration Building
New Castle, DE 19720
Ph: (302) 577-4460 x 35
Fax: (302) 577-4486
e-mail: farmstead@state.de.us
EXPERTS
Jim Haaven, M.A.
Oregon State Hospital
2600 Center Street, NE
Salem, OR 97310
Ph: (503) 945-9887
Fax: (503) 945-2867
e-mail:
Barry Maletzky, M.D.
Clinical Professor of Psychiatry
Oregon Health Sciences University
Director, The Sexual Abuse Clinic
8332 S.E. 13th Avenue
Portland, OR 97202
Ph: (503) 238-5580
Fax: (503) 238-0210
e-mail:
Jerry A. Rea, Ph.D.
Program Director
Parsons State Hospital and Training Center
P.O. Box 738
2601 Gabriel
Parsons, KS 67357-0738
Ph: (316) 421-6550 x 1752
Fax: (316) 421-1532
e-mail:
Anita Schlank, Ph.D.
Clinical Director
Minnesota Sexual Psychopathic
Personality Treatment Center
1111 Highway 73
Moose Lake, MN 55767
Ph: (218) 485-5300
Fax: (218) 485-5316
e-mail:
Craig Nelson, Ph.D.
Clinical Director
Atascadero State Hospital
10333 El Camino Real
P.O. Box 7001
Atascadero, CA 93422
Ph: (805) 468-2032
Fax: (805) 468-3408
e-mail: ty@thegrid.net
FACILITATOR
Bruce D. Emery, M.S.W.
Director of Technical Assistance
National Association of State Mental
Health Program Directors
66 Canal Center Plaza, Suite 302
Alexandria, VA 22314
Ph: (703) 739-9333 x 28
Fax: (703) 548-9517
e-mail: bruce.emery@nasmhpd.org
WRITER/RECORDER
Mary Leverette, M.S.
Director, Corrections Mental Health
Programs
Department of Human Resources
Mental Health & Developmental Disability
Services Division
2575 Bittern Street, NE
Salem, OR 97310
Ph: (503) 945-9485
Fax: (503) 378-3796
e-mail: leveretm@mail.mhd.hr.state.or.us
NASMHPD STAFF
Roy E. Praschil
Director of Operations
National Association of State Mental
Health Program Directors
66 Canal Center Plaza, Suite 302
Alexandria, VA 22314
Ph: (703) 739-9333 x 20
Fax: (703) 548-9517
e-mail: roy.praschil@nasmhpd.org
Table of Contents
Medical Directors Council